Dataset Information

Sex differences on outcomes of catheter ablation of ventricular tachycardia in patients with structural heart disease: A real-world systematic review and meta-analysis.

ABSTRACT:

Background

Sex differences have diversely affected cardiac diseases. Little is known whether these differences impact outcomes of catheter ablation of ventricular tachycardia (VT).

Objectives

To assess the impact of sex differences on outcomes of catheter ablation of VT.

Methods

Databases were searched from inception through December 2021. Effect estimates from individual studies were extracted and combined using the random-effects, generic inverse variance method of DerSimonian and Laird. The outcomes of interest included VT recurrence rates, all-cause mortality, and composite outcomes of mortality, left ventricular assistant device use, and heart transplantation following VT ablation.

Results

Our analysis included 22 observational studies. There were 10,206 patients, of which 12.8% were women. We found no statistical difference between sexes for VT recurrence rate (pooled hazard ratio [HR] 1.04, P = .57, I ² = 14.9%). Similarly, there was statistical difference in neither all-cause mortality nor composite outcomes (pooled HR 0.93, P = .75, I ² = 59.1% and pooled HR 0.9, P = .33, I ² = 0%, respectively). There was a trend toward an increase in women undergoing VT ablation in the recent registries (P = .071).

Conclusion

Our contemporary analysis suggests that sex may have no impact on clinical outcomes of catheter ablation of VT in patients with structural heart disease, though women are the underrepresented. However, recent VT ablation registries have involved more women in their studies. Future studies with a higher proportion of women are encouraged to verify the current perception.

SUBMITTER: Prasitlumkum N

PROVIDER: S-EPMC9795314 | biostudies-literature | 2022 Dec

REPOSITORIES: biostudies-literature

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Publications

Sex differences on outcomes of catheter ablation of ventricular tachycardia in patients with structural heart disease: A real-world systematic review and meta-analysis.

Prasitlumkum Narut N Navaravong Leenhapong L Desai Aditya A Chewcharat Pol P Gandhi Haresh H Perswani Prinka P Vallabhajosyula Saraschandra S Cheungpasitporn Wisit W Akoum Nazem N Jongnarangsin Krit K Chokesuwattanaskul Ronpichai R

Heart rhythm O2 20221216 6Part B

<h4>Background</h4>Sex differences have diversely affected cardiac diseases. Little is known whether these differences impact outcomes of catheter ablation of ventricular tachycardia (VT).<h4>Objectives</h4>To assess the impact of sex differences on outcomes of catheter ablation of VT.<h4>Methods</h4>Databases were searched from inception through December 2021. Effect estimates from individual studies were extracted and combined using the random-effects, generic inverse variance method of DerSim ...[more]

PMID: 36588991

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Project description:ObjectivesThis study sought to characterize ventricular tachycardia (VT) ablation outcomes across nonischemic cardiomyopathy (NICM) etiologies and adjust these outcomes by patient-related comorbidities that could explain differences in arrhythmia recurrence rates.BackgroundOutcomes of catheter ablation of VT in patients with NICM could be related to etiology of NICM.MethodsData from 2,075 patients with structural heart disease referred for catheter ablation of VT from 12 international centers was retrospectively analyzed. Patient characteristics and outcomes were noted for the 6 most common NICM etiologies. Multivariable Cox proportional hazards modeling was used to adjust for potential confounders.ResultsOf 780 NICM patients (57 ± 14 years of age, 18% women, left ventricular ejection fraction 37 ± 13%), underlying prevalence was 66% for dilated idiopathic cardiomyopathy (DICM), 13% for arrhythmogenic right ventricular cardiomyopathy (ARVC), 6% for valvular cardiomyopathy, 6% for myocarditis, 4% for hypertrophic cardiomyopathy, and 3% for sarcoidosis. One-year freedom from VT was 69%, and freedom from VT, heart transplantation, and death was 62%. On unadjusted competing risk analysis, VT ablation in ARVC demonstrated superior VT-free survival (82%) versus DICM (p ≤ 0.01). Valvular cardiomyopathy had the poorest unadjusted VT-free survival, at 47% (p < 0.01). After adjusting for comorbidities, including age, heart failure severity, ejection fraction, prior ablation, and antiarrhythmic medication use, myocarditis, ARVC, and DICM demonstrated similar outcomes, whereas hypertrophic cardiomyopathy, valvular cardiomyopathy, and sarcoidosis had the highest risk of VT recurrence.ConclusionsCatheter ablation of VT in NICM is effective. Etiology of NICM is a significant predictor of outcomes, with ARVC, myocarditis, and DICM having similar but superior outcomes to hypertrophic cardiomyopathy, valvular cardiomyopathy, and sarcoidosis, after adjusting for potential covariates.

Project description:BackgroundThe substrates for arrhythmias in myocarditis and ischemic heart disease (IHD) are different, but it is yet to be determined whether there is a difference in outcomes following catheter ablation (CA) for ventricular tachycardia (VT) associated with these two conditions. This study aimed to compare outcomes after CA of VT in patients with myocarditis versus those with IHD.MethodsPatients undergoing CA for sustained VT confirmed by endomyocardial biopsy as myocarditis, and patients with IHD experiencing sustained VT undergoing CA were retrospectively enrolled from February 2017 to March 2023. Initially, an endocardial approach was employed, reserving epicardial ablation procedures for non-responders. The primary endpoint was VT recurrence during follow up. All-cause mortality, repeat CA for VT and implantable cardioverter-defibrillator (ICD) implantation served as secondary endpoints. Kaplan-Meier curves compared outcomes between patient groups.ResultsThis study included 109 patients with IHD and 20 patients with myocarditis who underwent CA for sustained VT, from February 2017 to March 2023. Compared with IHD patients, myocarditis patients had a statistically significant lower complete short-term success rate of CA (60.0% vs. 85.3%, p = 0.013). During a follow-up period of 37 ± 21 months, 8 (40.0%) myocarditis patients experienced VT recurrence compared to 57 (52.3%) IHD patients, with no statistically significant difference between the two groups. During follow-up, 2 (10.0%) myocarditis patients died and 2 (10.0%) underwent repeat CA for VT recurrence, while 9 (8.3%) IHD patients died, 14 (12.8%) underwent a second CA for VT recurrence, and 8 (7.3%) received an ICD implantation. Additionally, there were no notable variations between the two groups regarding all-cause mortality, repeat CA for VT and ICD implantation.ConclusionsIt was demonstrated that the efficacy of CA in sustained VT in myocarditis patients was similar to that in IHD. For myocarditis patients with VT, CA might be equally effective.

Project description:IntroductionPatients with ventricular tachyarrhythmias (VT) are at high risk of sudden cardiac death. When appropriate, catheter ablation is modestly effective, with relatively high VT recurrence and complication rates. Personalized models that incorporate imaging and computational approaches have advanced VT management. However, 3D patient-specific functional electrical information is typically not considered. We hypothesize that incorporating non-invasive 3D electrical and structural characterization in a patient-specific model improves VT-substrate recognition and ablation targeting.Materials and methodsIn a 53-year-old male with ischemic cardiomyopathy and recurrent monomorphic VT, we built a structural-functional model based on high-resolution 3D late-gadolinium enhancement (LGE) cardiac magnetic resonance imaging (3D-LGE CMR), multi-detector computed tomography (CT), and electrocardiographic imaging (ECGI). Invasive data from high-density contact and pace mapping obtained during endocardial VT-substrate modification were also incorporated. The integrated 3D electro-anatomic model was analyzed off-line.ResultsMerging the invasive voltage maps and 3D-LGE CMR endocardial geometry led to a mean Euclidean node-to-node distance of 5 ± 2 mm. Inferolateral and apical areas of low bipolar voltage (<1.5 mV) were associated with high 3D-LGE CMR signal intensity (>0.4) and with higher transmurality of fibrosis. Areas of functional conduction delay or block (evoked delayed potentials, EDPs) were in close proximity to 3D-LGE CMR-derived heterogeneous tissue corridors. ECGI pinpointed the epicardial VT exit at ∼10 mm from the endocardial site of origin, both juxtaposed to the distal ends of two heterogeneous tissue corridors in the inferobasal left ventricle. Radiofrequency ablation at the entrances of these corridors, eliminating all EDPs, and at the VT site of origin rendered the patient non-inducible and arrhythmia-free until the present day (20 months follow-up). Off-line analysis in our model uncovered dynamic electrical instability of the LV inferolateral heterogeneous scar region which set the stage for an evolving VT circuit.Discussion and conclusionWe developed a personalized 3D model that integrates high-resolution structural and electrical information and allows the investigation of their dynamic interaction during arrhythmia formation. This model enhances our mechanistic understanding of scar-related VT and provides an advanced, non-invasive roadmap for catheter ablation.

Dataset Information

Sex differences on outcomes of catheter ablation of ventricular tachycardia in patients with structural heart disease: A real-world systematic review and meta-analysis.

Background

Objectives

Methods

Results

Conclusion

Publications

Sex differences on outcomes of catheter ablation of ventricular tachycardia in patients with structural heart disease: A real-world systematic review and meta-analysis.

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